Impact of pulmonary and extrapulmonary tuberculosis infection in kidney transplantation: A nationwide population-based study in Taiwan

S. M. Ou, C. J. Liu, C. J. Teng, Y. T. Lin, Y. S. Chang, S. C. Chiang, C. H. Tzeng, T. J. Chen

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Background: Tuberculosis (TB) has been reported to increase morbidity after kidney transplantation and pose a therapeutic challenge. However, population-based research, specifically focused on the association between kidney transplantation and subsequent pulmonary or extrapulmonary TB, is lacking. Methods: A nationwide population-based study was conducted using Taiwan's National Health Insurance Research Database, which provided claims data belonging to kidney transplant recipients during 1997-2006. Multivariate analysis was used to identify independent risk factors for TB after kidney transplantation. Kaplan-Meier survival analysis was used to assess the outcome of patients with TB. Results: Among 4554 kidney transplant recipients over the 10-year period, 109 (2.4%) patients with newly diagnosed TB were identified: 75 patients with only pulmonary involvement, and 34 with extrapulmonary spread. The incidence of kidney transplant recipients developing TB was 638 per 100,000 person-years. The independent risk factors for post-transplant TB included cyclosporine-based immunosuppressant agents during the first year after kidney transplantation (odds ratio [OR]: 1.98, P = 0.001), hepatitis C infection (OR: 1.79, P = 0.024), and chronic obstructive pulmonary disease (OR: 1.50, P = 0.041). Kidney transplant recipients who developed TB had a lower 5-year survival rate than those who did not (78.6% vs. 93.4%, P = 0.001). Conclusions: Kidney transplant recipients in Taiwan did have a high risk of TB infection, with high proportion of extrapulmonary spread. Physicians need to be vigilant in surveying for TB in kidney transplantation, especially in high-risk patients.

Original languageEnglish
Pages (from-to)502-509
Number of pages8
JournalTransplant Infectious Disease
Volume14
Issue number5
DOIs
Publication statusPublished - Oct 2012
Externally publishedYes

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Taiwan
Pulmonary Tuberculosis
Kidney Transplantation
Tuberculosis
Infection
Population
Kidney
Odds Ratio
Lung
Kaplan-Meier Estimate
National Health Programs
Immunosuppressive Agents
Survival Analysis
Hepatitis C
Research
Chronic Obstructive Pulmonary Disease
Cyclosporine
Multivariate Analysis
Survival Rate
Transplant Recipients

Keywords

  • Chronic obstructive pulmonary disease
  • Extrapulmonary tuberculosis
  • Hepatitis C
  • Immunosuppressants
  • Kidney transplantation
  • Pulmonary tuberculosis

ASJC Scopus subject areas

  • Transplantation
  • Infectious Diseases

Cite this

Impact of pulmonary and extrapulmonary tuberculosis infection in kidney transplantation : A nationwide population-based study in Taiwan. / Ou, S. M.; Liu, C. J.; Teng, C. J.; Lin, Y. T.; Chang, Y. S.; Chiang, S. C.; Tzeng, C. H.; Chen, T. J.

In: Transplant Infectious Disease, Vol. 14, No. 5, 10.2012, p. 502-509.

Research output: Contribution to journalArticle

Ou, S. M. ; Liu, C. J. ; Teng, C. J. ; Lin, Y. T. ; Chang, Y. S. ; Chiang, S. C. ; Tzeng, C. H. ; Chen, T. J. / Impact of pulmonary and extrapulmonary tuberculosis infection in kidney transplantation : A nationwide population-based study in Taiwan. In: Transplant Infectious Disease. 2012 ; Vol. 14, No. 5. pp. 502-509.
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abstract = "Background: Tuberculosis (TB) has been reported to increase morbidity after kidney transplantation and pose a therapeutic challenge. However, population-based research, specifically focused on the association between kidney transplantation and subsequent pulmonary or extrapulmonary TB, is lacking. Methods: A nationwide population-based study was conducted using Taiwan's National Health Insurance Research Database, which provided claims data belonging to kidney transplant recipients during 1997-2006. Multivariate analysis was used to identify independent risk factors for TB after kidney transplantation. Kaplan-Meier survival analysis was used to assess the outcome of patients with TB. Results: Among 4554 kidney transplant recipients over the 10-year period, 109 (2.4{\%}) patients with newly diagnosed TB were identified: 75 patients with only pulmonary involvement, and 34 with extrapulmonary spread. The incidence of kidney transplant recipients developing TB was 638 per 100,000 person-years. The independent risk factors for post-transplant TB included cyclosporine-based immunosuppressant agents during the first year after kidney transplantation (odds ratio [OR]: 1.98, P = 0.001), hepatitis C infection (OR: 1.79, P = 0.024), and chronic obstructive pulmonary disease (OR: 1.50, P = 0.041). Kidney transplant recipients who developed TB had a lower 5-year survival rate than those who did not (78.6{\%} vs. 93.4{\%}, P = 0.001). Conclusions: Kidney transplant recipients in Taiwan did have a high risk of TB infection, with high proportion of extrapulmonary spread. Physicians need to be vigilant in surveying for TB in kidney transplantation, especially in high-risk patients.",
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T2 - A nationwide population-based study in Taiwan

AU - Ou, S. M.

AU - Liu, C. J.

AU - Teng, C. J.

AU - Lin, Y. T.

AU - Chang, Y. S.

AU - Chiang, S. C.

AU - Tzeng, C. H.

AU - Chen, T. J.

PY - 2012/10

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N2 - Background: Tuberculosis (TB) has been reported to increase morbidity after kidney transplantation and pose a therapeutic challenge. However, population-based research, specifically focused on the association between kidney transplantation and subsequent pulmonary or extrapulmonary TB, is lacking. Methods: A nationwide population-based study was conducted using Taiwan's National Health Insurance Research Database, which provided claims data belonging to kidney transplant recipients during 1997-2006. Multivariate analysis was used to identify independent risk factors for TB after kidney transplantation. Kaplan-Meier survival analysis was used to assess the outcome of patients with TB. Results: Among 4554 kidney transplant recipients over the 10-year period, 109 (2.4%) patients with newly diagnosed TB were identified: 75 patients with only pulmonary involvement, and 34 with extrapulmonary spread. The incidence of kidney transplant recipients developing TB was 638 per 100,000 person-years. The independent risk factors for post-transplant TB included cyclosporine-based immunosuppressant agents during the first year after kidney transplantation (odds ratio [OR]: 1.98, P = 0.001), hepatitis C infection (OR: 1.79, P = 0.024), and chronic obstructive pulmonary disease (OR: 1.50, P = 0.041). Kidney transplant recipients who developed TB had a lower 5-year survival rate than those who did not (78.6% vs. 93.4%, P = 0.001). Conclusions: Kidney transplant recipients in Taiwan did have a high risk of TB infection, with high proportion of extrapulmonary spread. Physicians need to be vigilant in surveying for TB in kidney transplantation, especially in high-risk patients.

AB - Background: Tuberculosis (TB) has been reported to increase morbidity after kidney transplantation and pose a therapeutic challenge. However, population-based research, specifically focused on the association between kidney transplantation and subsequent pulmonary or extrapulmonary TB, is lacking. Methods: A nationwide population-based study was conducted using Taiwan's National Health Insurance Research Database, which provided claims data belonging to kidney transplant recipients during 1997-2006. Multivariate analysis was used to identify independent risk factors for TB after kidney transplantation. Kaplan-Meier survival analysis was used to assess the outcome of patients with TB. Results: Among 4554 kidney transplant recipients over the 10-year period, 109 (2.4%) patients with newly diagnosed TB were identified: 75 patients with only pulmonary involvement, and 34 with extrapulmonary spread. The incidence of kidney transplant recipients developing TB was 638 per 100,000 person-years. The independent risk factors for post-transplant TB included cyclosporine-based immunosuppressant agents during the first year after kidney transplantation (odds ratio [OR]: 1.98, P = 0.001), hepatitis C infection (OR: 1.79, P = 0.024), and chronic obstructive pulmonary disease (OR: 1.50, P = 0.041). Kidney transplant recipients who developed TB had a lower 5-year survival rate than those who did not (78.6% vs. 93.4%, P = 0.001). Conclusions: Kidney transplant recipients in Taiwan did have a high risk of TB infection, with high proportion of extrapulmonary spread. Physicians need to be vigilant in surveying for TB in kidney transplantation, especially in high-risk patients.

KW - Chronic obstructive pulmonary disease

KW - Extrapulmonary tuberculosis

KW - Hepatitis C

KW - Immunosuppressants

KW - Kidney transplantation

KW - Pulmonary tuberculosis

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